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MONITORING WELL INSTALLATION R KPwr(T <br /> Date: / I t 0/ d�, CONSCRUC170I/N <br /> ?remise Address:Z?r <br /> Total Depth r D <br /> Screen Length (from) (to) 1-0 <br /> Well No.: 104 � /S Filter Pack (from)-(to) - <br /> - <br /> Benronite (from) g (to)! <br /> Inspector. Grout (from). ( <br /> Drilling rig type <br /> Permit No. Auger O D. ffFq I.D. 4-h <br /> Drilling Company: <br /> e.4SeA,& <br /> Completion - Stove pipe/christie box (circle one) <br /> Driller. Casing <br /> height <br /> Consultant <br /> Geologisr , <br /> �� �iH[ TWIV <br /> V ABCVE-GROUND CRUSTY-aox <br /> CC IO <br /> °TN l=i,CN <br /> SPECIAL PERMIT INFO. GfO171d Suf'c' <br /> i <br /> Disrancd to sewer line <br /> Domestic well on-site - ( y/ n ) <br /> If yes, location and distance - ! fL <br /> - <br /> i.. _ s <br /> ,SAMPLING sic <br /> w�cn -_ <br /> Holding Temperature ��L = , PX <br /> Method <br /> Screening Merhod X a <br /> Tracking Sheet n) v : <br /> SPOILS Tlj f/6 <br /> Storage Method MAT'ERIAIS/DEVELOP.ME <br /> Contamination Noted - (y/ n) w <br /> Storage Location Casing type - <br /> Blank J,,2 fL Seen <br /> Slor size e>.016 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Z Bags sand/gravei 9 <br /> Mix Ratios gyp Filter Pack typesize z- J� <br /> Installation Method Surge Block: - (y//,V) <br /> Quantity Installed Y71 '10 Discussed with gec ogisc - ( }/ a) <br /> Type of method vv <br /> EH 29 29 <br />